美国国家公共电台 NPR To Grow Market Share, A Drugmaker Pitches Its Product To Judges

 

AILSA CHANG, HOST:

More than 130,000 Americans will go through drug courts this year. They're often charged with possessing drugs or stealing, to feed their habit. To avoid jail, they're offered treatment. And sometimes, that includes medication to treat addiction¹. One pharmaceutical² company sees an opportunity here. It markets its drug, Vivitrol, directly to court officials, who have no medical training. And now, some courts favor the drug over other treatment options. Jake Harper of Side Effects Public Media reports.

JAKE HARPER, BYLINE³: Philip Kirby started using heroin⁴ about five years ago.

PHILIP KIRBY: When I was addicted⁵, you know, I was addicted. You can't really dabble⁶ in it.

HARPER: Late last year, he was pulled over and charged with possession. He went to jail for a few months before entering drug court in Hamilton County, north of Indianapolis. But before Kirby started the program, he says court officials pressured him to get a shot of Vivitrol.

KIRBY: They made it seem like they were forcing it upon me, like I couldn't come into the program until I got it.

HARPER: Vivitrol is a drug called naltrexone. One shot blocks opioid receptors in the brain for a month. It's one of three FDA-approved medicines for opioid addiction. But doctors warn that some patients will do better with other treatments. And it can have side effects. Kirby says he reacted badly to it, that he got a bad rash.

KIRBY: I had sinus problems, chest problems for the whole month I was on it. And I couldn't shake it.

HARPER: The drug court Kirby went through doesn't allow other medications for treating addiction. In fact, we've identified at least eight drug courts in Indiana that say they only allow participants to use Vivitrol. One reason Vivitrol is so prominent in drug courts is that its manufacturer, Alkermes, is doing something unusual. Its sales reps market directly to judges.

This is happening across the country. Drug court officials in Missouri and Ohio also said they were contacted by sales reps. Here's how this can play out. Judge Lewis Gregory heads the Greenwood City Court, south of Indianapolis. And about a year and a half ago, Gregory didn't allow participants to start on medication.

LEWIS GREGORY: And we were failing miserably⁷ with the heroin population.

HARPER: He only knew about two opioid addiction medications, and they're opioids, buprenorphine and methadone. When prescribed properly, they prevent withdrawals⁸ and help patients feel normal. But sometimes, the drugs are sold on the street and misused⁹.

GREGORY: I was certainly not going to do a medication-assisted treatment program with drugs which people use to get high.

HARPER: But then Gregory got some Vivitrol literature in the mail and a phone call from an Alkermes representative.

GREGORY: And so we ended up meeting in the early part of 2016, and she began educating me a bit.

HARPER: He said she gave him the pitch. Vivitrol is not an opioid. It blocks opioid receptors. And that was appealing to Gregory. Six months later, his court began permitting Vivitrol. He said the sales rep even sits in on treatment team meetings. Vivitrol sales could reach $300 million this year. At an investor¹⁰ pitch last year, policy director Jeff Harris said that drug courts are an important market.

(SOUNDBITE OF ARCHIVED RECORDING)

JEFF HARRIS: Think about this - there are over 3,000 counties in the United States, and there are over 3,000 drug courts.

HARPER: Alkermes has said it supports the use of all medications for addiction. But in practice, it doesn't. Previous reporting from NPR and Side Effects found that the company lobbies state and national lawmakers for policies that favor Vivitrol and even, in some cases, hamper¹¹ access to the other medications. And drug courts are another place the company can grow sales. But most drug companies don't market to courts.

ADRIANE FUGH-BERMAN: I have not heard of a drug company going after judges before.

HARPER: Adriane Fugh-Berman researches pharmaceutical marketing¹² at Georgetown University. She and other experts I spoke¹³ with say that marketing to judges and criminal justice officials isn't just unique; it's inappropriate.

FUGH-BERMAN: They're not health care providers. They don't know data. They don't know research.

HARPER: Alkermes declined repeated interview requests. In a written statement, the company defended its practices by noting that judges don't actually prescribe their product. But Basia Andraka-Christou, a researcher at the Fairbanks School of Public Health, says court officials do influence treatment decisions. That's why the company is marketing to them.

BASIA ANDRAKA-CHRISTOU: The judges in these cases are actually making a lot of the medical decisions, and that should be very concerning to everyone.

HARPER: Some judges only allow Vivitrol in court-ordered treatment, and others prefer it over other medications. But they argue that they don't mandate¹⁴ Vivitrol. Judge Gail Bardach runs the Hamilton County Drug Court, the one Philip Kirby went through.

GAIL BARDACH: We encourage it, but we never force anybody - never have, never will.

HARPER: But faced with potential jail time, participants don't always feel like getting the shot is a choice. To be clear, even if it doesn't feel like a choice, it can work for the right patients. Jeremy Templin was arrested for theft when he was 19 and addicted to heroin.

JEREMY TEMPLIN: I don't remember any of it. I don't remember what was stolen or any of that. I was in a blacked-out stage.

HARPER: He spent a few months in jail. Then, he was offered a spot in the Hamilton County Drug Court, and he got Vivitrol.

TEMPLIN: I don't know what it would have been like without it. I can't speak for that, but I know that I did have it. And here I am today, you know. I'm still alive.

HARPER: Still, addiction experts warn that using Vivitrol as a one-size-fits-all solution is a bad idea. People who go on Vivitrol lose their tolerance¹⁵ to opioids. So if they stop treatment, as many people do, and go back to using drugs, they're at a greater risk of overdosing. Dan Mistak is an attorney with Community Oriented Correctional Health Services. He says courts should let doctors determine which medication is right for each patient.

DAN MISTAK: We rely on outside experts all the time in the judicial¹⁶ systems. We don't ask a judge to come in and be an expert in arson¹⁷. And so I think for these clinical decision-makings, I think that this is a responsibility that a judge doesn't want.

HARPER: Both the federal government and the National Association of Drug Court Professionals agree, and they endorse¹⁸ all addiction medication options. But getting courts to follow best practices is another matter. In some areas, buprenorphine and methadone providers are hard to find. And without clear rules in place for all of the drug courts in the U.S., some courts will continue to prefer Vivitrol over other treatments.

Phillip Kirby, who you heard from in the beginning, says his probation¹⁹ officer kept pushing him to stay on Vivitrol until he revealed a rash covering his body, another possible reaction to the drug. I could still see splotches on his arms months later.

KIRBY: This is like scarring from it.

HARPER: Yeah.

KIRBY: Yeah, it's all cleared up except for these scars. I don't know if they'll go away. I hope they would go away eventually.

HARPER: In May, he was kicked out of drug court when he got caught with marijuana and sent to prison. He says he wish he never took Vivitrol in the first place. For NPR News, I'm Jake Harper.

(SOUNDBITE OF THE DAYDREAM²⁰ CLUB'S "IMPROV #10 - ONE LAST THOUGHT")

CHANG: This story was produced in collaboration²¹ with Side Effects Public Media and WFYI.

1 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

2 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

3 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

4 heroin   

n.海洛因

参考例句：

• Customs have made their biggest ever seizure of heroin.海关查获了有史以来最大的一批海洛因。
• Heroin has been smuggled out by sea.海洛因已从海上偷运出境。

5 addicted   

adj.沉溺于....的，对...上瘾的

参考例句：

• He was addicted to heroin at the age of 17.他17岁的时候对海洛因上了瘾。
• She's become addicted to love stories.她迷上了爱情小说。

6 dabble   

v.涉足，浅赏

参考例句：

• They dabble in the stock market.他们少量投资于股市。
• Never dabble with things of which you have no knowledge.绝不要插手你不了解的事物。

7 miserably   

adv.痛苦地；悲惨地；糟糕地；极度地

参考例句：

• The little girl was wailing miserably. 那小女孩难过得号啕大哭。
• It was drizzling, and miserably cold and damp. 外面下着毛毛细雨，天气又冷又湿，令人难受。 来自《简明英汉词典》

8 withdrawals   

n.收回，取回，撤回( withdrawal的名词复数 )；撤退，撤走；收回[取回，撤回，撤退，撤走]的实例；推出（组织），提走（存款），戒除毒瘾，对说过的话收回，孤僻

参考例句：

• He has made several withdrawals from his bank account. 他从银行账户上提了几次款。 来自《简明英汉词典》
• It is not the bank's policy to deduct interest on withdrawals. 提款需扣除利息这并非是本银行的政策。 来自辞典例句

9 misused   

v.使用…不当( misuse的过去式和过去分词 )；把…派作不正当的用途；虐待；滥用

参考例句：

• He misused his dog shamefully. 他可耻地虐待自己的狗。 来自《简明英汉词典》
• He had grossly misused his power. 他严重滥用职权。 来自《简明英汉词典》

10 investor   

n.投资者，投资人

参考例句：

• My nephew is a cautious investor.我侄子是个小心谨慎的投资者。
• The investor believes that his investment will pay off handsomely soon.这个投资者相信他的投资不久会有相当大的收益。

11 hamper   

vt.妨碍，束缚，限制；n.(有盖的)大篮子

参考例句：

• There are some apples in a picnic hamper.在野餐用的大篮子里有许多苹果。
• The emergence of such problems seriously hamper the development of enterprises.这些问题的出现严重阻碍了企业的发展。

12 marketing   

n.行销，在市场的买卖，买东西

参考例句：

• They are developing marketing network.他们正在发展销售网络。
• He often goes marketing.他经常去市场做生意。

13 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

14 mandate   

n.托管地；命令，指示

参考例句：

• The President had a clear mandate to end the war.总统得到明确的授权结束那场战争。
• The General Election gave him no such mandate.大选并未授予他这种权力。

15 tolerance   

n.宽容；容忍，忍受；耐药力；公差

参考例句：

• Tolerance is one of his strengths.宽容是他的一个优点。
• Human beings have limited tolerance of noise.人类对噪音的忍耐力有限。

16 judicial   

adj.司法的，法庭的，审判的，明断的，公正的

参考例句：

• He is a man with a judicial mind.他是个公正的人。
• Tom takes judicial proceedings against his father.汤姆对他的父亲正式提出诉讼。

17 arson   

n.纵火，放火

参考例句：

• He was serving a ten spot for arson.他因纵火罪在服十年徒刑。
• He was arraigned on a charge of arson.他因被指控犯纵火罪而被传讯。

18 endorse   

vt.(支票、汇票等)背书，背署；批注；同意

参考例句：

• No one is foolish enough to endorse it.没有哪个人会傻得赞成它。
• I fully endorse your opinions on this subject.我完全拥护你对此课题的主张。

19 probation   

n.缓刑(期)，(以观后效的)察看；试用(期)

参考例句：

• The judge did not jail the young man,but put him on probation for a year.法官没有把那个年轻人关进监狱，而且将他缓刑察看一年。
• His salary was raised by 800 yuan after his probation.试用期满以后，他的工资增加了800元。

20 daydream   

v.做白日梦，幻想

参考例句：

• Boys and girls daydream about what they want to be.孩子们遐想着他们将来要干什么。
• He drifted off into another daydream.他飘飘然又做了一个白日梦。

21 collaboration   

n.合作，协作；勾结

参考例句：

• The two companies are working in close collaboration each other.这两家公司密切合作。
• He was shot for collaboration with the enemy.他因通敌而被枪毙了。